A Conversation with Dr. Fauci and Longtime HIV/AIDS Researcher and Advocate, Greg Millett

A Conversation Between Dr. Anthony Fauci and HIV-AIDS Researcher and Advocate, Greg Millett. Welcome, Dr. Fauci. It's wonderful to have you here today for this discussion. I'm looking forward to this interview because I really wanted to cover a lot of the incredible work that you've done around HIV, but then to also talk about some of the contemporary things that are taking place with infectious disease and some of the similarities and perhaps differences that you might be noticing with some of these things that are taking place. Sure. And then to talk a little bit about you personally and who are some of the influences in your life and some other questions about you. Thank you. Well, happy to do that. Great, great. Well, before we begin, we're both New Yorkers. I was born and raised in New York, you as well. And I remember going to Greenwich Village to go visit my dad at St. Vincent's Hospital. The village at the time in the 1980s was really the epicenter of the HIV epidemic. And I remember seeing a lot of people who were dying literally from HIV. It was a very difficult period. And the amount of stigma was overwhelming as well. What was it about HIV early in the 80s that made you believe that this was something that you wanted to study? Well, there were a number of factors, Greg, that went into that. One, from a purely scientific standpoint, I had been trained both from a research standpoint, but from a clinical standpoint, in the fields of infectious diseases and clinical immunology. So I'm double-boarded. I have infectious disease boards, clinical immunology boards, and internal medicine boards. So I'd guess you'd say I'm a bit over-trained, as it were. But when I realized very early on, and when I say very early on, I'm talking about the summer of 1981, when we start getting the first cluster of cases in the United States, that this was clearly an infectious disease that we didn't know what the etiology was, but it clearly was a transmissible infection, sexually transmitted, and it was destroying the body's immune system. So I just felt scientifically, as an immunologist and infectious disease person, that this was something that was almost made for my efforts and my training. So from a purely scientific. But also, I have had, from my training, I guess, going back to my parents, a very strong feeling of service, public service, but also of empathy towards those who are at a disadvantage, be that with their health, with their social situation, or what have you. And here we had, at the time, not now, but at the time, what looked like exclusively young, otherwise previously healthy gay men, who were stigmatized even beyond HIV because of the disenfranchisement at the time, and to some extent even now, of gay men in the population. There's discrimination, disenfranchising. I always felt the pain and an empathy towards them. You superimpose upon that a mysterious disease, which historically, well beyond just the United States, someone is always looking to blame some population for a disease. So you had these young gay men, many of whom I knew, who actually were stigmatized for two reasons, and it was a double whammy. One, stigmatized for being gay in a population that has discrimination against gay men, and then superimposed upon it a disease that's a disenfranchised disease, because people look and say, well, gay men get this disease, there must be something wrong here. So I felt a very strong affinity that somebody needed to do something about that, and one of those persons happened to be me. So that's how I actually got involved. Well, that's incredible, because there's a lot that you've mentioned in that answer that I'd love to unpack. One of them is, you talked about your training and intellectual curiosity with this new disease, but there's another side of it, I think for most humans, which is just fear. It's an infectious disease. A lot of people didn't know much about it. Did you have any moments of pause around HIV at the very beginning of the epidemic? And then I also want to ask a little question about stigma. You mentioned some of the stigma that was taking place at the time. Do you have any examples of some of the stigma that either you faced or any of your patients faced very early on in the epidemic? Well, no doubt stigma was pretty obvious. Some of it was particularly painful for the patients, because there was the external stigma of society against gay men, and against gay men with a mysterious disease. But the thing that was so painful to watch, and certainly for my patients to have experience, was stigma from within their own family, where a parent or a brother or a sister would withdraw from a family member who was sick, desperately ill, purely on the basis of that this disease pointed out that they were in this situation where they were a gay man. We saw a lot of bravery on the opposite side of that, of family members who rallied to support in a wonderful way. But those were some of the things I experienced. The other thing which was sort of strange was there were some people, not a lot, but some people who shied away from me and my wife, who was an AIDS nurse at the time, because we were dealing with this mysterious disease, which people weren't fully convinced was not transmitted by casual contact. As the months and the years went by, there was overwhelming scientific data that it was not spread by casual contact. But when people heard that we were taking care of these people with this strange, deadly disease, there was an element, thankfully a small element, who sort of shied away from us. You asked me, did I ever have any hesitancy? The answer was absolutely not. I mean, I've been trained as an infectious disease person, and that's the life you choose. You're going to be dealing with infections, some of which are going to be transmissible. So either you're going to go in there and roll up your sleeves and get involved, or you're not. And I knew long before HIV that you're an ID doc, that's your responsibility, no questions asked. That's really amazing. And I think one of the other amazing aspects of a lot of this is, you know, despite the fact that you had a lot of that stigma that was leveled at you, leveled at your family, the stigma just around being associated with HIV, and particularly gay men at the time, you also saw the value of working with communities, and particularly communities and advocates who were living with HIV. And up until that point, there really wasn't a lot of community-based models of scientists working closely with advocates or people who are affected by a particular disease. Could you talk a little bit more about that experience and what that's been like? Yeah, well, there were two elements of that. There was working with a community that was a community that was easily interacting with the scientific community, the mothers of children with cancers and things like that. That was not done a lot of. I think the whole idea of community interaction with the HIV-AIDS community was transforming and set the model ever since then. I mean, no one's going to argue with that. I mean, history has shown that. But it was particularly interesting because at the time, the community was very sophisticated and realized that the standard paradigm of the scientific approach and the regulatory approach towards a new disease and the interventions that you would need for prevention, treatment, and care were completely non-suited to the reality of what HIV-AIDS was, where you had people who, by the time they presented with their disease and their infection, they were advancing their disease, and the life expectancy was measured in not a very long period of time. Yet the clinical trial process was rigid, that if you want to test a drug, these are the inclusion criteria and these are the exclusion criteria, which made it very difficult for someone who was desperately ill to get an intervention. Then there was the regulatory rigidity, which said when you design a clinical trial, these are the issues that will allow you to get in and these are the issues that say you can't. And the community had some issue with that appropriately, not in an inappropriate way. One, not enough attention was being paid. There was not the proper use of the bully pulpit of the government, particularly the president at the time. There was a rigidity in the process. They wanted to have input. They didn't want to control the process, the gay community at the time, mostly gay men, some injection drug users, but they at least wanted a seat at the table. And when no one was listening to them, they became confrontative. Retrospectively, quite appropriately confrontative. And they were theatrical, disruptive about saying you got to listen to what we're saying. That paradoxically and unfortunately put off the scientific and the regulatory community. And one of the things that I feel is among the things that I've done in the now 41 years that I've been involved in this was I listened to what they were saying and got past the theatrics and the confrontational aspects and listened to what they were saying. And what they were saying was making perfect sense. And I said to myself, if I were in their shoes, what would I be doing? And I would be doing exactly what they were doing. So that's when I said, now, wait a minute, we got to have a coming together with the community if we're going to be successful. Coming together and understanding each other, coming together and incorporating them and their ideas into the design of clinical trials, into the scientific agenda, and into the regulatory process. And I think that just opened up the gates to what we see now four decades later of not only an extraordinary interaction with the AIDS community and the HIV community and the regulatory and scientific process, but now we are continually asked by other disciplines and other diseases about how did you do that? Tell us how to do that because that was really a very successful model. And successful indeed. I mean, I've been asked the same thing from other disciplines in terms of how did this work? Is there any ways that we could capture lightning in a bottle again, like the HIV community has done, to really make sure that this applies to other communities and to other diseases? But I do think that there are some things, though, where we see some similarities today as compared to the very beginning of the early part of the HIV epidemic. Over the last several years, I remember even as early as maybe four or five years ago, the scientific community was talking a lot about the rise of non-communicable diseases and how non-communicable diseases were really the future and that infectious disease, the era of infectious disease was disappearing. But since that time, we have seen COVID-19, we have seen polio and sewage and wastewater, we have seen measles outbreaks, we have seen monkeypox and many other infectious diseases. Essentially, there's a viral storm that's taking place currently. Why do you think we're seeing that and what does this mean? Well, it's all part of the process that I have been speaking about with all due honesty for like 50 years and 40 years. When I was a medical student and an intern and a resident in medicine, you're talking in the late 1960s, a very prominent and wonderful infectious disease icon, Bob Pietersdorf, made a statement at a medical meeting that the era of infectious diseases is essentially over. He said, we don't really need to train them anymore because we essentially have vaccines, we have antibiotics. He was a bright guy. He got that one really wrong. Even earlier, some even public health officials were saying that. What they failed to realize was the dynamics of the continual emerging and re-emerging of infectious diseases because of a number of factors. Environmental encroachment on the human-animal interface, where the human environment and the animal environment come together. 75% of all the new infections are zoonotic, jumping from an animal to a human. Going back to HIV, you have chimpanzees, HIV. You have influenza, birds, chickens, pigs. You have Ebola coming out from an animal. You have Zika coming out from an animal. You have monkeypox coming out from an animal. It really is that as we encroach upon the environment more and more, as climate change has an influence on the location of things like mosquitoes and the ability of animals to come back out of the forest into the arena of people where there's population, all of that is contributing to that. So this is not a new phenomenon. It's always been there. He just ratcheted up a bit by encroaching upon that animal-human interface. I think that one of the things, and you really got at this in your last response, that's remarkable is how all of this is happening simultaneously. I can't help but think about a tweet that I saw from an epidemiologist who is remarking on the fact that in New York City on September 9th, that New York City had a state of emergency for polio, for COVID-19, as well as for monkeypox. And the fact that we're in this period right now where infectious disease really is at the forefront. Thinking about that, what do you think are some of the advances after 50 years and 40 years, particularly in HIV research? What are some of the amazing advances that we've seen in HIV research that have really helped leverage us in our fight against other infectious diseases? Well, there have come some, there's a lot of examples, but some just fly out at you. The first is the targeted drug development of antivirals. Antivirals was a very nation type of a discipline many years ago. When HIV came along, it utilized the targeted-based drug design, which means you look at the replication cycle of the virus, and you identify certain vulnerable components of that cycle, and you design a structure-based design of a molecule to interfere. You have reverse transcriptase. You have the nucleoside and non-nucleoside reverse transcriptase inhibitors. You have protease, an important enzyme. You develop a protease inhibitor. You have integration of the pro-virus into the genome of a cell. You have an integrase inhibitor. You have binding of the virus to the cell. You have a binding infusion inhibitors. So even though there was antiviral development before HIV, it really came into its own with HIV, which immediately hepatitis C leveraged right off that. With COVID now, the same thing, looking at the replication cycle of SARS-CoV-2 and designing molecules, they could be protease inhibitors, polymerase inhibitors, to do the same thing. That's one example. I'll give you another example, but there are so many I don't want to take too much time. The other one is the structure-based vaccine design, where you take the cryo-EM approach to getting the right confirmation of the envelope molecule to be used as a vaccine candidate. Even though we haven't developed a vaccine for HIV, that structure-based vaccine design and immunity design was used by Barney Graham and his colleagues and all his collaborators from all over the country to develop the mutations that stabilized the spike protein in its prefusion form to give us a COVID vaccine that has already saved millions of lives. So in both therapy and vaccine, HIV-AIDS research and the investment that we made in research has dramatically impacted in a very positive way hepatitis C and COVID. Again, I could give you other examples, but those are two outstanding ones. I really appreciate those two examples and the explanations. I think in many ways, the explanations that you just gave really highlights one of the many keys to your success, which is being able to explain science in a way for public consumption that people can understand. I remember being in White House meetings with scientists who are coming in from outside of the field who are trying to explain to policymakers certain concepts and just watching eyes glaze over almost instantly, and also seeing that too on Capitol Hill. But you really have been able to break that barrier and to be able to communicate in a way to the general public that people understand and are really curious about in terms of science. What do you think are some of the successes for that type of effective communication, particularly from basic science? Well, there are certain fundamental principles that I learned very early on. I credit partially, not completely, but heavily to my training in the Jesuit tradition of training, both in high school and in college. I have eight years of Jesuitical training, which is very intellectually based and some fundamental principles. One of them is precision of thought and economy of expression. So know what your message is and don't blabber on, get right to it. The other one is know your audience and aim your... You don't talk down or talk up. You aim your message knowing who your audience is. If your audience is the senior staff at the White House, don't talk to them like they're the National Academy of Sciences, nor talk to them like they're eighth grade. Talk to them at the level that they are at. And the one thing that is, I think, the one lesson, Greg, that I tell young fellows and residents and interns and people in my lab when they ask the lesson of the communication is the important goal of your speaking to somebody is not to impress them how smart you are, it's to get them to understand what you're talking about. Because I have seen also at White House meetings where people come in and they start talking like they want the end game to be, guess how smart I am, and the end game is not how smart you are, it's whether the person you're talking to understands what you're talking about. Absolutely, absolutely. I also have another quick question around that as well, just a quick follow up, in terms of how have you seen communication change over the last 30 years? I mean, the internet is really revolutionized in some ways, the way that people interact and creating groups where people who experience various diseases can find support for one another, where people can find information at their fingertips. I think another problem, though, is that people can find information at their fingertips, and it might not necessarily be correct or factual information. How does that interact with the type of rules that you have for effective communication? That complicates it greatly, because it's a very important double-edged sword, and double-edged in a very positive way for the translation and the availability of information that you've just described, which in its purest form is all good, to get good, correct information to people. But the social media now has had as much of a deleterious effect, and in some respects, counterbalances and sometimes overwhelms the positive effect. When you get people out there in a completely unedited way, really propagating not only misinformation, but disinformation, that has complicated greatly the field of communication. Because when you have all of these inherently contradictory things being said, the general default position of the public is either nobody knows what they're talking about, or they pick out the thing that most coincides with their own prejudice. So if they're a person that has suspicion and conspiratorial thought, well, then the conspiratorial information fits right in with them. If they're people who mistrust government, the mistrust of government fits right in. When you have that kind of misinformation, disinformation, it really makes communication difficult, and it makes it even more important and compelling for people who have the correct information to get out there much more, because it seems that those with the incorrect, mis- and disinformation seem to have a lot more time to do it than the people with day jobs that are trying to do some good work and at the same time communicate. Have you had any experiences where you might have had an occasion to meet somebody who might have had some misinformation about any particular type of infectious disease, but then having an opportunity to have some sort of breakthrough with them, where they really understood, well, maybe I was thinking about this incorrectly, and perhaps this is the way that I should have been thinking? Oh, there are multiple examples of that, but it doesn't come easily. The first thing, don't make the mistake of condemning people who have been the victims of disinformation and misinformation to make them feel like they're stupid, or they did something wrong. If they ask a question that sounds off the wall, don't treat them as an off-the-wall person. Treat the question as an off-the-wall question, and then try and explain to them why, quite frankly, when evidence doesn't support that at all. Look at the evidence and try to convince them. It's a great response because you're bringing me back in some ways to talking about the way that we treat people and how people should be treated. It brings me back a little bit to talking about stigma. You addressed beautifully a lot of the stigma that you faced, that your patients faced very early on in the HIV pandemic. Are we seeing a rise in stigma again? We saw it from COVID-19, where certain groups are stigmatized. Now with the monkeypox outbreak, you're seeing a lot of the same thing, too. Why do we continue to have these outgroups, or these marginalized groups, whenever there's a new infectious disease outbreak? Well, that's just the nature of diseases and the public's response to a disease. There seems to be almost a reflex of where did it come from and whose fault is it? That's the reason why you go back a hundred years. You would give the name of the Italian plague or the Spanish flu or whatever it was. People need to hang the cause of something on someone, some demographic group, some country, but something or somebody. That's just almost one of those quirks of human nature. We want a reason that satisfies us to say, oh, it's somebody else's doing. That leads to the inevitability of stigma, unfortunately. Yeah, it's certainly unfortunate that we haven't quite learned the lessons yet from this. We're unfortunately doing the same thing over and over again. I want to talk about something a little brighter in terms of this incredible career that you've had over the past 50 years. As you think back on that, where do you see some of the highlights and some of the research breakthroughs and things that you have had a hand in? Well, Greg, I've been very privileged and fortunate to have had the opportunity to wear three separate hats over the last 54 years and particularly over the last 38 years that I've been director of NIAID. It's the hat as a scientist and a clinical scientist, the basic and clinical scientist, the hat as the director of what has turned out to be a powerhouse institution of infectious diseases globally, and the hat that I wear as a policy person that had the privilege of advising seven presidents dating back to Ronald Reagan. The first thing as a scientist is that in my early years, I had the opportunity even prior to HIV to develop a group of illnesses that had a very high degree of mortality, 95 percent, the inflammatory vasculitides like granulomatosis, polyangiitis, or polyarteritis nodosa, rare diseases but deadly. And I had the privilege with some others of developing what were really essentially high remission inducing therapies that are now textbook, so everybody uses them now. So I feel good about that as an individual. And then my research on HIV, which I still do now and it's 41 years later, is to develop an understanding of the pathogenic mechanisms of HIV which actually opened up the door to the development of therapy. So that's me as a scientist. Me as the director, the hat number two of the director of the NIAID, to bring it from a small, somewhat sleepy institution among NIH institutes, we were ranked sixth or seventh in resources and our budget was $360 million when I came in. It's now $6.4 billion. But among that was to develop an AIDS program that was responsible for the development of, together with industrial partners, of the life-saving drugs that have now saved millions of lives throughout the world. The bulk of the science was coming from either scientists here or our many, many grantees throughout the country and the world. That's hat number two. Hat number three is that being in that position, I was able to be the advisor to seven different presidents and we did really good things with all of them. But one stands out is that during the George W. Bush administration, he asked me, and I gladly accept, to work with him to be the principal architect of the President's Emergency Plan for AIDS Relief, or PEPFAR. And interesting, I devoted about seven or eight months of my life doing that as sort of my second job as being the director and doing that down at the White House week after week, day after day, working with the White House staff under President George W. Bush. And we put it together, the program, and everybody knows now, more than 20 years later, about 20 years later, that that program has saved anywhere between 18 and 20 million lives. So that's something that I feel very good about as having the privilege of doing that. But all the credit in the world goes to President George W. Bush for that. The PEPFAR program is perhaps the most successful global health program that we have ever had in the United States. I think there's no doubt about that. Absolutely, absolutely. And the number of lives that it saved is just incredible. It makes me think that you've almost had this career that's bookended, where you're coming full circle, where you've seen the beginning of an incurable disease to now a career where near the end, myself and many others have heard you say over and over again, we now have the tools to end the HIV epidemic. And there's actually efforts that you have spurred to end HIV, both domestically as well as globally. How does that feel to actually start with an infectious disease where people had no idea where it came from, where there was no cure, to where you're actually talking about ending it? Yeah, I mean, it's an extraordinary feeling that by circumstance alone, very few physicians and scientists have had the opportunity to be there before it started, when it started, and as you see the end of it. That's an amazing feeling. But it takes over 40 years to do that. It's not something that you can do in a month or two months or something like that. But remember, it isn't only me. It was so many, many, many people, basic scientists, clinical scientists, administrators, community. I mean, without the community cooperation, I don't think this would have happened. It was just as we discussed a moment ago, is an amazing interaction between the at-risk and afflicted community and the scientists and the administrators to take it from a frightening mystery. I remember it like it was yesterday, and it was 41 years and three months ago, when in June of 1981, I saw the first cases described in the MMWR. And then a month later, another 26 cases, and I made a decision that changed my direction of my career and my life when I said, this is what I'm going to study. And to have the feeling of 41 and a half years later to say, wow, we got treatments, we got U equals U, we got PrEP, we got PEP. It's just amazing. You never would have thought we had that or would ever get that 41 years ago. Absolutely. Well, we even saw it in a smaller period of time with COVID-19, where it came from nowhere. There's a lot of fear. We shut down the country, many other countries shut down as well. But within a two-year period, we already had effective vaccines. And therapies. And therapies. I'm able to speak to you right now without my mask on, because I've had all of my wonderful vaccines that are predicated on HIV research. I mean, it's incredible to see in one career that you've been able to see this, not just once, but in other areas as well. I feel very privileged. I mean, I've worked hard, but I've been lucky. Well, I think we're all very thankful for all the work that you've done. Now, of course, I've come to the inevitable part of the interview, where instead of talking about all the things that you've done in your career, I just want to talk a little bit about you. One of the things that I remember that always made me smile when I was in the White House was when we were talking about scheduling particular meetings with you and when you might be available. And some of it was based upon, well, is Tony going for his run at that point? Is he jogging then? Is he working out in some fashion? And putting all the rest of us to shame, mind you. But I love the fact that you're a doctor who practices what you preach. How did you develop first this hobby of taking time to exercise every day? And what does it do for you? Does it create some space where you can think about other things? Does it help you out in some other ways in your career? Well, it started off, you know, my younger days in school. I was an athlete in high school. I played sports in high school. And I always enjoyed the athleticism of keeping your body fit. That slowed down a bit when I got in the intensity of medical school because of the time constraints. But once I got out and realized that exercise for me is an amazing stress reducer, number one. It really sometimes when you feel your head is exploding with stress and that when you go out, get the fresh air, whether it's cold in the winter or that balmy weather in the summer or in the spring or even when it's hot. The fact is there's a certain feeling physically and mentally that interaction between the mind and the body that it really relieves stress. But it also feels good to be in shape. I mean, when you feel that your body is in shape and you're lucky enough to be healthy, that really spills over into making what you do mentally and emotionally much, much more easy and appears much more normal. So it becomes part of your existence. So when you were saying when we were scheduling meetings is, you know, when is Tony going to go for his run? That's to me as much of my existence as eating. Like, are you going to have breakfast or lunch? And this to me is it, are you going to go for a run? And that's what I've done over decades and decades. And it's turned into, you know, running several marathons and running dozens and dozens of 10ks. But also because I sometimes I'm concerned that I'm not physically a 25 year old person anymore at 81. I still walk power walk every day about three or four miles. Wow. And I don't run the way I used to run. But as my wife tells me, at least you're walking. That's a good start. It's amazing. Three or four miles every day. Yeah. It's incredible. That's something I wish that I could certainly adopt for sure. And I'm sure many of us who are listening to this. There's a couple of other things I want to ask about you personally as well. You know, we always talk about how many people you've mentored. I mean, myself included, and many other scientists who have been interested in HIV work and HIV research. But who were your mentors when you were starting? Who were the people who influenced you in the work that you do? Well, in the field of medicine, one that stands out, and I think that person stands out as what the qualities of a mentor should be. When I first was thinking of coming to the NIH, I was recruited here only because someone knew somebody. When I was a student and a resident at the New York Hospital Cornell Medical Center, the head of gastroenterology there was a guy named Marvin Schlesinger. And he was very good friends with a person down here who was a young clinical director of NIAID named Sheldon Wolfe, W-O-L-F-E. And Shelly was a phenomenal clinician and a good scientist. Not a molecular biology gene cloning scientist, but a good clinical investigator. And he recruited me down here, and I was in his group for the three years that I was a fellow. And he was a mentor in the form of being incredibly generous and unselfish in the time that he spent with helping to teach you the fundamentals of what clinical research is, but also putting you on a project and making it clear that failure is an option. You know, you've often heard failure is not an option, where just go ahead and do it and have fun with it and get excited by it. And he put me on some very good projects that he thought of that I didn't think of. I was unqualified to think of a good project. I just got out of medical school. I didn't do an MD-PhD. It was just an MD. And I was doing clinical medicine, and he said, you know, this is a reasonable idea. Why don't you take it and run with it? And he gave me a project that was highly, highly successful that led me to then develop my own creative ideas. So he kind of started the engine going, and once the engine got it going, it became clear that I did have a lot of creative ideas. But he really instilled in me that, and he did it in an incredibly unselfish way. So if everybody had a mentor like that when they started, then it's interesting because after that, there were people who, I would call them mentors, mentors, but they were even at a lower level than I when I just looked at what they did and said, wow, this is really something special what they're doing. And one person stands out very much like that is Paul Farmer, who became a very close personal friend of mine. And I met Paul when Paul was a medical student at Harvard, and I was giving a lecture to the Harvard Medical School class on HIV AIDS. And he tells me, I think he said that to make me feel good. He said, when I sat down and saw your lecture, I was totally transfixed, and I knew that HIV was something I really wanted to get involved with. He had already started his Partners in Health in Haiti, so he had already been doing it. But he said to me, you were really my inspiration and my mentor. And as we got to become very close over the decades, it was clear that he was a mentor to me, actually, because I used to look at what he did. And he was a classic example of, you know, roll up your sleeves, get in the trenches and do it. And that's what I learned from him. So I learned from an older person who taught me and I learned from a younger person who taught me. So it's both ends, you get it. And you're doing it. I mean, you're where it's nice to see this incredible pipeline that you've developed here at NIH, where it's not just drug development, but getting the drugs into people's arms. And really, you know, some of the science around that, how do we make sure that this is available for people? And it's wonderful to see that arc as well. You know, as we look and think about your 50 years in research, if you could just go back in time to when you were younger, just to discuss some, you know, what are some of the things that were life lessons and learn in terms of research? What would they be? But how would you speak to younger Tony, about some of the things that you've done? How would you counsel younger scientists about some of the things that they could do? Yeah. Well, that's a question I get frequently, but the answers are maybe two or three aspects of the answers. One is pick something that you are really excited about. Because it's hard work in research, because there are a lot of failures. I mean, there were probably more failures, and experiments that didn't work than there are experiments that were because if you're asking a difficult enough, and important enough question, you're not going to hit a home run every time you go to the plate. You're going to strike out a few times, ground out a few times, a couple of singles. Every once in a while, you'll hit one out of the park. But it doesn't happen that often. So you got to do something that you're passionate about what you're doing. That's point number one. The other one that's probably as important, if not more important, is keep your mind open for opportunities that you weren't anticipating. And you might have a path that you want to take that even though you've been planning for two or three years to do this, all of a sudden an opportunity will come in front of you that you may want to change direction or pursue a pathway that you didn't plan. The epitome of that for me was HIV. Because I came back from my chief residency in medicine in 1972. And from 1972, and even earlier from 1968, during my fellowship, I pursued a direction of research that was involved predominantly in studying the dysregulation and the regulation of the immune system with immune-mediated diseases, autoimmune-type diseases. And I was very successful. And my trajectory of my career was like this. And I liked it. But something was missing. The globality of it was missing. The fact that it could impact many, many people as opposed to a rare disease. And along came HIV in 1981. And I made a decision at that time that my mentors warned me was a career-ending decision. Why would you want to stop what you're doing, which is so successful, and studying a very small group of young gay men who have a disease that likely will go away in a month or two? That's what the attitude at the time was. I mean, people didn't take this as something that was going to be what it turned out to be. And I said, you know, there's something about this disease that is fascinating me. It's an unknown disease. It's mysterious. It has immunological components and infectious disease components. I'm an infectious disease person. I'm an immunologist. I'm sorry. I'm going to put this aside, and I'm going to go study this. And it was a risky thing that I did. But it turned out to define the next 41 years of my research life. So my advice to young people is keep an open mind. Expect the unexpected. Things may come in front of you that would change the direction or modify, maybe not change as dramatically as I changed, but modify the direction that you're going in. Always be flexible. It's terrific advice. And, you know, on behalf of people living with HIV, as well as people affected by HIV, I just have to thank you, Tony, for all of the incredible work that you've done. For many of us, many people would not be alive if it were not for the work that you and your colleagues have done over the last 40 years at NIH. And it really is incredible. All right. Thank you. Thank you. My pleasure. Good to be with you. Likewise. Likewise. Produced by the U.S. Department of Health and Human Services.